Federal auditors said the University of Minnesota Medical Center should acquittance added than $3.2 actor in estimated overpayments for casework they said were afield billed to the Medicare program, according to a address actuality appear Wednesday.
Auditors advised 225 claims for payments in 2012 and 2013 and begin the hospital did not absolutely accede with Medicare announcement requirements in 130 cases, said the address from the Office of the Inspector General for the U.S. Department of Bloom and Human Services.
Based on the sample results, auditors appraisal the U hospital accustomed overpayments accretion added than $3.2 actor during the time period.
“These errors occurred primarily because the hospital did not accept able controls to anticipate the incorrect announcement of Medicare claims aural the called accident areas that independent errors,” auditors concluded.
The University of Minnesota Medical Center said it would accord the government the abounding acquittance bulk but is ambrosial the allegation in 23 of the 130 specific cases, according to a account from Minneapolis-based Fairview Bloom Services, which owns the U hospital.
“If those appeals are successful, Fairview would again get some of that back,” said backer Cindy Fruitrail. “We aren’t able to quantify the bulk at this time.”
More broadly, the hospital said it would address the government’s adjustment for extrapolating costs from the sample of claims reviewed. The auditors “found alone $565,286 in absolute overpayment,” Fruitrail said in the statement.
The assay goes to the federal Centers for Medicare and Medicaid Services, which will accomplish a final assurance on how abundant money to seek afterwards audition from the U hospital.
Located in Minneapolis, the University of Minnesota Medical Center is one of the state’s better medical centers. It’s the U’s primary teaching hospital and is accordingly managed by Fairview and the University of Minnesota Physicians.
Medicare is the federal bloom allowance affairs for bodies who are 65 or earlier and for assertive appropriate populations. Medicare paid the U hospital about $376 actor for 12,864 inpatient and 262,335 outpatient claims for casework in 2012 and 2013, according to the report.
The government launched the assay as allotment of a alternation of acquiescence reviews actuality conducted at medical centers beyond the country. Auditors acclimated computer matching, abstracts mining and assay techniques to analyze assertive types of hospital claims that are at accident for contravention with Medicare announcement requirements.
The assay begin eight types of announcement errors at the U hospital. The better dollar amount was affiliated to 71 claims area the hospital billed Medicare for outpatient dental casework at a absolute amount of $240,352, according to the report. Medicare about does not awning hospital outpatient dental services, the assay noted.
In a acknowledgment that’s allotment of the assay report, the U hospital said it agreed with those findings. “Since these patients had Minnesota Medicaid which does accommodate dental coverage, a announcement action had been created to bill primary allowance afore announcement accessory insurance,” wrote John Doherty, acting admiral at University of Minnesota Medical Center. “Denials … were accepted but allegedly did not occur.”
But Doherty’s letter said the U hospital disagreed with assay allegation in four categories. It questioned the award that assertive rehabilitation casework were afield billed at an inpatient level. Doherty additionally disagreed with the address on whether assertive cases of Medicare acquittal for inpatient affliction should accept been billed for outpatient or “outpatient with observation” care.
Auditors said they stood by their findings. “We subjected these [contested] claims to a focused medical analysis to actuate whether the casework met medical call and coding requirements,” the address said. “Each case that was denied was advised by two clinicians, including a physician. We angle by those determinations.”
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